Ethical Dilemmas in Home Healthcare

Whether you’re a social worker, therapist, visiting nurse or another type of home healthcare practitioner, you will undoubtedly face an ethical dilemma at some point in your career.

These quandaries can relate to a patient’s safety, competency or confidentiality, reimbursement or a host of other issues that force home healthcare workers to act. Three home healthcare professionals shed light on issues they must consider when dealing with these ambiguous day-to-day home-care predicaments.

Assessing Competency

Patients who put themselves at risk pose a dilemma for social workers, says Lisa Yagoda, LICSW, ACSW, a senior policy associate for the National Association of Social Workers. These patients may refuse medical treatment or services or reject common-sense advice.

Home Health Aide: Should I Give it a Try?

1. I like to be independent and have a lot of control over my day-to-day work.

True
False

“Patients have a right to refuse treatment or services, but there are risks associated with doing so,” Yagoda says. “If the patient is supposed to use a walker and won’t, if the patient refuses to eat the home-delivered meal, if the patient can’t remember to take medication, then the social worker has to decide what is the appropriate action.”

The dilemma lies in determining whether the patient is competent, Yagoda explains. And the social worker is responsible for assessing whether the patient understands the consequences of his behavior.

“A team approach to solving ethical dilemmas is ideal,” she says. “We work with other disciplines, like nurses or physical therapists, to give the client a different perspective and explain to them why the rug or the pile of books on the floor is dangerous. If the patient still refuses and is at a great enough risk, it should be reported to the primary-care physician.”

Confidentiality Conundrum

“If you have concerns about a patient’s judgment, is your obligation solely to that client?” asks Janie Scott, director of practice and ethics for the American Occupational Therapy Association. “Or is the obligation to the family as well? Or to the referring authority? Do you breach confidentiality by sharing those concerns? Where does the client’s protection enter into the discussion?”